Thread by @JohnHenryDean

Inspired by @runthelistpod’s exceptional episode on “Starting Intern Year During a Pandemic,” here is my first attempt at a #tweetorial on the topic of GOC family meetings 1/18

Since @walkerreddmd & @emily_gutowski provided such a great discussion on the added challenges of having humanistic family meetings during the #COVID19 pandemic, let’s touch on some fundamentals 2/18

The following points are gleaned from an “ADLS (Advanced Disease Life Support) Interprofessional Primary Palliative Care” module by my mentor, role model, and friend, the #twitterless Dr. Tim Short @uvahealthnews 3/18

Think of family meetings as a surgical procedure – when done well ➡️ can offer hope and healing, but when done poorly ➡️ can potentially result in harm and injury to patients and families 4/18

Trust is critical in these meetings & at the heart of trust is listening – goal should be to allow patient/family to speak more than the team 5/18

Let's talk about prognosis: which of the following has the least literature supporting its accuracy in predicting prognosis? 6/18

Interestingly, the patient's will to live has the least supporting evidence in regards to accurately predicting prognosis. However, often times, will to live seems to trump the other 3 predictors. 7/18

Now, a word on language. It is very important to try to speak in the family’s language of caring - using words like hope, meaning, importance, and quality of life instead of medical jargon 8/18

Common pitfalls to avoid:
⏺️Going into meeting with your own agenda
⏺️Starting meeting with code status discussion
⏺️Expecting everyone to be happy with outcomes/discussion
⏺️Holding meeting without all important participants
⏺️Using family member as interpreter 9/18

Alright, now let’s get to how to have an effective family meeting! First and foremost, meetings are only as good as the interprofessional huddle before! 10/18

Structure of effective huddle: Where/What/Who
⏹️Where will meeting take place (patient room vs elsewhere)?
⏹️What is understanding of patient’s condition & prognosis?
⏹️Who will lead meeting, update patient condition/prognosis? 11/18

Structure of effective meeting: Who/What/Where
⏹️Focus on who the patient is and what is important to them
⏹️What is family's understanding of their loved one’s condition?
⏹️Bridge between what and where is prognosis
⏹️Where do we go from here? 12/18

Remember to always ask permission to talk about prognosis and options moving forward! 13/18

Families will often ask: what would you do if this was your loved one – proposed answer, “It’s not my loved one, but if it were, here is how I would approach it.” Then try to guide family to speak to loved one’s wishes in light of current context 14/18

What about making a recommendation?
✅Start by asking if family would like your recommendation
✅If yes, consider the following elements:
1. Who is patient and what is important to them?
2. What is most likely clinical outcome? 15/18

Finally, don’t forget to get input from interprofessional team and family before reflecting and summarizing decisions! 16/18

Let’s summarize:
• Only agenda is family’s agenda
• Huddle is critical
• Try to limit interruptions and sit down for meeting
• Start by allowing family to express what is important to patient
• Ask permission as you progress through meeting and recommendations 17/18

Thanks so much for reading!! Here is the title slide to the resource for the tweetorial: Dr. Short’s ADLS module. Any and all feedback is invited & appreciated! 18/18 @MedTweetorials